Von Bronchitis bis Influenza: Tiefe Atemwegsinfektionen – Indikation zur Antibiotikatherapie genau prüfen!

Infekte der Atemwege zählen in der täglichen Praxis zu den häufigsten Gründen für eine Arztkonsultation – insbesondere in den jetzt bevorstehenden Wintermonaten. Rund ein Drittel der Atemwegsinfekte betreffen den unteren Respirationstrakt. Hierzu zählen neben der der häufigsten Form, der akuten Bronchitis, auch die exazerbierte chronisch-obstruktive Lungenerkrankung (COPD), die ambulant erworbene Pneumonie (CAP) und die Influenza. Typische Symptome sind neben einem allgemeinen Krankheitsgefühl Fieber, Husten mit oder ohne Auswurf, Dyspnoe sowie Kopf- und Gliederschmerzen. Im Alltag werden die meisten Betroffenen antibiotisch behandelt, obwohl ein Effekt der Antibiotika nicht in allen Fällen nachgewiesen ist. Während Patienten mit einer CAP immer eine leitliniengerechte antibiotische Behandlung erhalten sollten, ist ein Nutzen bei der akuten Bronchitis und einigen Formen der exazerbierten COPD nicht belegt, da sie meist nicht bakteriell bedingt sind. Gerade in den Zeiten zunehmender Antibiotikaresistenzen ist die Vermeidung von unnötigen Verordnungen jedoch dringlicher denn je.

Infections of the respiratory tract are one of the most common reasons for GP consultations, especially in the oncoming winter season. Almost one third of these infections aff ect the lower respiratory tract, comprising acute bronchitis, the most frequent form of lower respiratory tract infections (LRTI), exacerbated chronic obstructive pulmonary disease (AE-COPD), community-acquired pneumonia (CAP), and infl uenza. Common signs and symp toms of LRTI include compromised general condition, fever, cough with or without expectoration, dyspnea, headaches, and myalgia. In every day practice, most patients receive antibiotic treatment, although an advantage of this treatment is not proven in all cases. Whereas all patients with CAP should receive antibiotics in accordance with recent guidelines, there is no indication for antibiotic treatment in acute bronchitis and some cases of exacerbated COPD, because of their mostly non bacterial origin. Especially in times of rising antibiotic resistances thoughtful prescribing of antibiotics is needed more than ever.

lower respiratory tract infection (LRTI) - acute bronchitis - acute exacerbation of chronic obstructive pulmonary disease (AE-COPD) - communityacquired pneumonia (CAP)

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1 Global initiative for chronic Obstructive Lung Disease

2 Confusion, Urea, Respiratory rate, Blood pressure

3 Kompetenznetz Ambulant Erworbene Pneumonie

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